This chapter presents arguments as to why participation is important for improving life situations, particularly for the poor and disadvantaged, including people with disabilities and their families. It begins by noting that the contribution of participation to health development is not easily agreed upon. It then, outlines the reasons for participation in health development and how this has affected the development of community based rehabilitation programmes. Ways of defining and assessing community participation are discussed. The penultimate section identifies critical issues that must be addressed in considering participation as a basis for CBR programme planning, giving examples from the Ugandan context. The conclusion points to the complexity and challenges that participation presents, for planners and managers of community based health and disability programmes.